Nurse Papa Teaches Lessons on Life and Death

 Title: Nurse Papa; 16 Meditations on Parenthood From a Pediatric Oncology Nurse

Author: David Metzger

Publisher: Genz Publishing

Publication Date: August 17, 2021

Length: 175 Pages

About the Author
David Metzger has worked as a pediatric oncology nurse at UCSF Children’s Hospital for twelve years. He is the father of a young son and daughter. The bravery, laughter, perseverance, and the many smiles of the children and their parents who he has worked with have inspired this project.
You can visit the Nurse Papa blog and the Nurse Papa podcast at www.nursepapathebook.com

Life as a Nurse and Papa
David Metzger writes about the lessons that he learned about life and death as a pediatric oncology nurse. He uses his experiences at work to gain insight and understanding of his role as a father to two young children. His life at work and at home intertwine to form a wonderful collection of the author's most cherished memories.

My Thoughts

It is not natural to talk about children and cancer in the same sentence, but Mr. Metzger has dedicated his life to caring for children with cancer. He writes about some of his most memorable patients and the valuable lessons he learned from them. 

I could tell that the author was growing as a person and becoming more compassionate and empathetic as the book progressed. He gives credit to his patients for teaching him to live and die with dignity and grace. He credits his children for teaching him to live in the moment and appreciate all that life has to offer.

There are some very emotional stories in this book because many children with cancer do not survive the disease. The author focuses on the celebration of life instead of the sadness of death. 

This book was well-written and I am glad I read it. I now have a new respect for all the superheroes who wear a nurse's uniform.

MY RATING: 5 STARS OUT OF 5

FYI - I received a free digital copy of this book from NetGalley in exchange for a fair review.

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A Transplant for the Cure - Tomorrow

Sign pointing to the Bone Marrow Transplant area
at the University of Kansas Medical Center

Tomorrow is Day Zero for our long-awaited stem cell transplant. The past two days have been filled with clinic visits and a little sight-seeing on the side.

I have been plagued with sinus problems since I arrived in Kansas City. A bit of stuffiness in my head turned into a painful earache, pressure in my neck, and jaw pain. At times it felt like my teeth would fall out. I have been taking two Neupogen shots a day for the past four days, and I think this has aggravated my head problems.

The nurse at the clinic told me that I could only take Extra-Strength Tylenol for the pain. After much discussion, a doctor prescribed a 14 day supply Amoxicillin. I don't know if I really have an infection, or if my ear/head ailments are side effects of the Neupogen shots. It appears they are going to take my stem cells and then send me home sick.

Tomorrow, I report to the BMT Apheresis room at the University of Kansas Medical Center. Lois will drive me to the hospital for my 7:00am appointment. The nurses will check my veins and determine if they can take the stem cells from my arms. I am hoping and praying they will be able to do this. I will then sit in a dentist-style chair for four to five hours while they take blood out of one arm and put the unused blood back in my other arm. The apheresis machine will filter out the needed stem cells.

If they can't use the veins in my arms, I will have to have a line surgically inserted into my chest. The blood will then be take from the line, filtered through the apheresis machine, and then back to me through the line in my chest. A nurse called today and said that if I have to have the line in my chest, they will keep me in the hospital for one night. They will then harvest more stem cells the next day. 

The long hallway to the Apheresis area of the hospital.

Karen's schedule tomorrow includes a visit to the BMT clinic in the morning, radiation treatment at the KU Medical Center Hospital in the afternoon and the stem cell transplant at the hospital in the evening. She will then be sent home for the night and report back to the BMT clinic on Wednesday morning. That is the plan, if all goes well.

I will be very glad when this is over and Karen has a brand new immune system to fight any remaining cancer cells in her body. Many patients consider a stem cell transplant as a type of "birthday", a fresh start.

I know that many, many of our family and friends have been praying for us and the success of the stem cell transplant. I want to thank each one of you and tell you that we know you are with us in your thoughts and prayers. The next few weeks will be critical in Karen's recovery, so please continue to keep us in your prayer.

I want to especially thank my Uplifters Life Group from First Baptist Church, Conroe, Texas. They have been supporting me in prayer every step of the way.

 Surely goodness and mercy shall follow me all the days of my life: and I will dwell in the house of the Lord for ever.
Psalms 23; 6. 

A Transplant for the Cure - Transplant Countdown

Karen is keeping detailed medical records for the transplant.

We are only three days away from transplant. The time is going very fast. We had a good day today. I had my third and fourth Neupogen shots this morning. They were injected into my stomach but did not sting and burn as much as yesterday. I think I had the first day jitters yesterday, but today was much better. The only side-effects that I am feeling from the Neupogen are a series of headaches. My head is also congested and I have a cough, but this could be from a change in climate and environment. I have been taking Extra-Strength Tylenol for the headaches and it helps a great deal.

Karen received a breathing treatment and her second pre-transplant chemotherapy treatment this morning. She is feeling amazingly well during these treatments. The transplant is entirely outpatient so Karen will not spend any time in the hospital.

This is how Karen recently described her transplant in a Facebook post;
The stem cell process is a relatively simple one. Janette will get some shots of Neupogen to cause her morrow to release more stem cells into her blood. Then they will hook her up to an apheresis machine that will filter out her stem cells and give her back the rest of her blood. Then they will give me the stem cells though an iv and they will graft into my morrow and start killing the cancer cells. They have found it is no longer necessary to completely destroy my immune system before giving the new cells, just suppress it. Since our HLA codes and blood types are identical, I am believing and expecting this new immune system to develop successfully with no infections or rejection issues. Bless the Lord who heals all my diseases and redeems my life from destruction. Goodness and mercy will follow me through this valley right to the next mountain top. I will start 3 days of chemo today, one day off then a full body radiation followed by the infusion of the new cells. Believe with me for supernatural protection from the side effects of the chemo and radiation.

Lois Crane is standing outside the KU Cancer Clinic

Lois (our younger sister) and I had to leave the treatment room this morning while Karen received her breathing treatment. We used this time to explore the KU Cancer Clinic building. We went outside the front door and took a picture of Lois standing by the name of the clinic. We then sat down on a bench, and decided to take a selfie of the two of us with our shades on. A nice man walked by and asked us if we would like for him to take our picture. What fun!

When we returned home from the clinic, Karen wanted to take a nap. Lois and I went to an Italian restaurant and had a big pasta meal. I was feeling very energetic UNTIL I got back to the house. A full belly and an inviting bed was all I needed to take a little power nap. I dozed-off for about two hours, and felt refreshed and restored when I got up.

Sisters - Janette and Lois.

Tomorrow is Sunday. We have an appointment at the Cancer Clinic at 10:00am for Karen to get her final pre-transplant chemotherapy treatment. I will get my third set of Neupogen shots.

Before I close, I want to mention an outstanding book I read on my Kindle. The title of the book is, "My Cancer, My Faith; One Man's Battle With Cancer, and His Reliance on Faith During His Journey" by Jim Davis. I would like to end with a quote from this book;

"If you are ever feeling down, or feeling that life has taken a recent turn for the worse, just take a couple of hours sitting in the waiting area outside a chemotherapy treatment center. It won't take long for you to see that things could be a lot worse, a whole lot worse." 

A Transplant for the Cure - A Tow Truck and a Prayer

Karen Luehrman and Janette Fuller at
Confederate Memorial Park, Higginsville, Missouri

Karen's car spent the night of October 20th in the parking garage at the University of Kansas Cancer Center. She called her car insurance company and discovered they would tow a car up to ten miles without an additional charge.

She decided to have the car towed to the Firestone Complete Auto Care at 1100 Kansas Avenue, Kansas City, Kanas.

Our mother went with us so that she could drive Karen home after the scope procedure at the hospital and I would drive Karen's car home when/if it was repaired.

Karen had an appointment at the Bone Marrow Transplant Clinic at 10:00 am. She would receive her IV treatment and then go over to the hospital for the surgical procedure to take a culture of the infection in her lung.

Karen said the tow truck would be arriving around 11:00 am, so I made a quick stop at the snack bar and then headed for the garage. I alternated between sitting in the car and pacing around the outside of the car. Each time I heard a truck engine, I got out to see if it was the tow truck. When Karen finished with the IV treatment in the clinic, I was still waiting for the tow truck. There had been a miscommunication between the insurance company and the dispatcher at Kid's Towing Service. The wrecker finally arrived at 12:45 and Karen signed the required paperwork.

The tow truck hitched-up to Karen's car, and I climbed into the passenger seat of the wrecker. I think I rode in a wrecker one other time, but it had been a long time (I live a sheltered life). The driver was a pleasant young Hispanic man with an iPad set up on the console of the truck running a GPS program. I told him that I was going to be a stem cell donor for my sister, and he said that his mother was a cancer survivor.

My heart sank as we drove out of the affluent residential neighborhood and into an older commercial/industrial area of Kansas City, Kansas. I had a map in my purse, but I had no idea where I was. I thought,

"How am I going to get out of here? Lord help me!"

I asked the driver if we were very close to I-70. He said the Firestone Store was only about a mile from the highway, and it was easy to find the way. He showed me exactly where to turn. I just had to turn left out of the parking lot, go through three traffic lights and turn left. I would go over a bridge and turn right at the light at the bottom of the bridge onto I-70 East.

We arrived at the Firestone Auto Care Center, and I went inside while the driver unhooked the car. Karen had already talked to the manager about the radiator problem. I sat down and waited for about an hour and a half.

The manager called me over and had a puzzled look on his face. He said, 

"I have some good news and bad news. The good news is that we couldn't find anything wrong, and the bad news is that we couldn't find anything wrong."

They ran diagnostic tests on the hoses, the thermostat, and the water pump. The only thing wrong was the radiator had run low on coolant. They refilled the coolant and just charged me $21.00.

A young mechanic came in and said that he used to work at Shafer's Car Care Center in Higginsville. It is a small world.

I reviewed the directions with the Firestone manager and slowly walked out to the car. I would be driving an unfamiliar car right through the middle of Kansas City. I was praying hard that the radiator would make it the 80 miles to get me safely home. I kept a close watch on the engine temperature gauge and white-knuckled it all the way back to Higginsville. (A week later Karen took her car to a Chevrolet dealership to be checked-out. They did not find anything wrong with the radiator, hoses, thermostat or water pump.) 

I made it! I got back to the house about 3:45. I called my mother, and she said that Karen was in the recovery room. They would be on their way home soon. Mom is not fond of driving in the city, but she did not have any trouble driving with Karen directing her.

Karen had two outpatient surgeries in the past two days. I think God put some good people in our paths during this time, and I am very thankful.

A Transplant for the Cure - Angels All Around You

Entrance to the Bone Marrow Transplant Clinic at the
University of Kansas Cancer Center

Karen's schedule was full of appointments for Tuesday and Wednesday, October 20th and 21st.
Our first stop was an out-patient surgery center in Overland Park, Kansas. We made a couple of wrong turns (we got lost) on the way to our destination, so we arrived at the center right at 10:00 am.
Karen would have a tri-line surgically inserted to facilitate the anti-fungal IVs that she would administer each day at home.

They called Karen back to the operating room and said that she would be ready to go in about two hours. I took this opportunity to call my former college suitemate and good friend, Ann Null. I knew she lived in the area, and I hadn't seen her in several years.

Ann and her granddaughter drove over to the surgery center and picked me up for a quick lunch. Since our time was limited, we went to the drive-through at a taco shop and went back to the surgery center to eat in Ann's van. We had a great time catching up and reminiscing with lots of laughter.

I walked back to the surgery center, and a nurse came out looking for me right away. She said Karen was awake and would be ready to go soon. Karen was very alert but was advised not to drive for 24 hours, so I was at the helm when we drove from the surgery center back to the BMT Clinic.

I am not familiar with the streets in the area, but Karen was a good navigator. I drove Karen's car about ten miles without any problems. We pulled into the parking garage at the Cancer Center and proceeded to go up several levels to find a parking space. Just as I was pulling into the parking space, I noticed steam coming from under the hood. Karen opened the hood, and the radiator coolant was spewing out onto the ground.

Karen was already late for her appointment to have another IV anti-fungal treatment. She had not had anything to eat since the night before so we ran down to the snack bar and got a sandwich and back up to the clinic for the treatment.

Karen knew much more about car repair than I did. She thought it might be a leaky hose or a faulty thermostat in the radiator. The first challenge would be to figure out a way to get the car back home or to a nearby repair shop. It was 5:00 pm before Karen completed her IV treatment. She decided to try to get a ride home and deal with getting the car repaired the next morning.

Karen called her long-time friends, Bruce and Linda Barnes, to help us. Linda was out of town, but Bruce volunteered to drive from his home in Blue Springs and pick us up and take us to our home in Higginsville, Missouri. He said that he and Linda had been trying to think of a way they could help Karen.

It was almost dark when we got home. It had been a long day. We were very appreciative that Bruce was willing to take us home.

The next day would bring more challenges and require me to get out of my comfort zone and venture into unknown territory. Looking back on those days, I thought of the old gospel song, "Angels All Around You".

In a world full of trouble we travel along.
God is our Father, we're on our way home.
If forces of evil ever close in on you,
Jesus has promised, this is what He will do.

Chorus
Put angels all around you to keep you from harm,
To guide and direct you, 'till you're safe in His arms.
With angels all around you, you're never alone
And you'll be protected 'till you make it home.

A Transplant for the Cure - A Fungus Among Us

Karen Luehrman is filling out paperwork and waiting to
review the CT scan with the pulmonary physician.

Our first stop on Monday morning, October 19, was at the University of Kansas Hospital/Office Building.
Karen had been suffering from a persistent cough for several months, so her doctor ordered a CT Scan of her lungs. The pulmonary physician showed us a picture of the recent scan and pointed out a filmy-looking white area in her upper left lung. He then showed us a scan from several months earlier. There was a noticeable difference, even to an untrained eye.

The pulmonary doctor said they needed to find out if this was a virus, fungus or bacterial infection in her lung. He scheduled Karen to come back on Wednesday so they could put a scope into her lung and get a sample of the tissues. This issue in the lung was the reason the stem cell transplant was postponed.

We then went over to the KU Cancer Center and checked-in at the Bone Marrow Transplant Clinic. I had a series of appointments for my pre-donor tests and Karen had other appointments on her schedule.

I was required to repeat the same medical tests that I had in May. The following tests are required of a stem cell donor:

Chest X-Ray
Labs (Blood Tests)
EKG
Health & Physical/ Consent Appointment

The first three tests were routine and uneventful. The "consent" appointment was an opportunity to meet with one of the transplant oncologists and discuss any questions or concerns. The doctor was a pleasant young woman with a British accent (I am not good at accents, but it sounded British to me). She began our conversation by saying;

"Your stem cells will help Karen so much. They will do her so much good".

I was happy to hear that the doctor was still quite optimistic that this transplant was going to happen. There had been several delays, but the doctor seemed  hopeful and optimistic about the entire situation. Sometimes a few well-chosen words can change everything for the better.

The doctors suspected that Karen had a fungal infection in her lung. They would not know for sure until they got the results of the scope procedure being done on Wednesday. However, they started her on an anti-fungal drug that had to be administered intravenously.

Karen Luehrman was receiving her first dose of
anti-fungal medicine with an intravenous injection.

Karen would have to take this anti-fungus medicine for at least two weeks, so the doctors scheduled a surgical procedure for a tri-line to be inserted in her chest so she could give herself the IV treatments at home.

I would be extremely squeamish about giving myself IV treatments at home. Karen didn't have a moment of hesitation about doing whatever it took to get well. She would not surrender to the disease.

Tuesday would be another full day of medical procedures. Karen would report to a day surgery facility to have the tri-line inserted into her chest and then back to the BMT Clinic to receive her IV treatment. The day ended with an unexpected challenge and a little help from a friend.

A Transplant for the Cure - Complications and Cancellations

Ellen Maxwell, R.N. Blood and Marrow Coordinator.
University of Kansas Cancer Center.

Karen contacted the KU Bone Marrow Transplant Clinic and told them that she would like to move forward with preparations for a stem cell transplant. I received the following email from the transplant coordinator on October 1st:

I  hope this finds you well.  I have just spoken with Karen who informs me she is willing to proceed with the transplant.  Are you still on board with donation? 

 She is coming back to discuss her decision with a physician  within the next few days.  They will be very firm about her commitment to this treatment. 

If she feels ready to commit we would be able to proceed with her pre-transplant work-up  within a few days.  

I am looking ahead to some potential dates…if you were here for your labs, etc on 10/19, Karen would consent on the 22^nd and admit to the hospital on the 23^rd then transplant ( and your collection) would be on the 29^th.  You could travel home the 31^st.  Your neupogen injections would be the 25^th thru the 28^th.

Please let me know your thoughts and please let me know what questions you have!

 

I was just recovering from a stomach virus when I got this email. I didn't think Nurse Maxwell REALLY wanted to know my thoughts on this day. I was disappointed that the medical tests that I had done in May would have to be repeated. That meant I would have to be away from home for two full weeks.

 

I reserved a ticket with Southwest Airlines to fly from Houston to Kansas City on October 17th and return on October 31th. I found that reserving flights with only two weeks advance notice could be a real challenge. I searched for an open flight that would not cost me an arm and a leg. I settled on a ticket flying from Houston to Kansas City via Chicago and flying back to Houston from Kansas City via Denver.

 

On October 13th, I was shocked to get the following email from Nurse Maxwell;

 

I am sorry but I am going to ask you to delay your arrival and I am cancelling your appointments for next Monday.  During the team meeting this afternoon this decision was made by the physician team.  I will let you know as soon as I can when we will be able to reschedule.

 

I called Karen to ask her what was going on with the schedule. She said she didn't know anything about this cancellation but would get back to me as soon as she could get some information.

 

Karen discovered that she had missed an appointment with a doctor the day before. The problem was, this appointment was not on her printed schedule. The clinic said they had confirmed this appointment with Karen on the telephone, but Karen did not remember getting a call.

 

At first it looked like the transplant would be postponed because of this scheduling blunder. This uncertainty was making me crazy. I did not want to cancel my airline reservations if the transplant was just postponed a few days. I made several calls but had trouble getting a satisfactory answer. It was finally decided that they would go ahead and harvest my stem cells on October 29th, EVEN IF Karen was not able to have the transplant on that day. My stem cells could be frozen and used for the transplant at a later date.

 

I had a good flight to Kansas City on October 17th and enjoyed some time with my family that weekend. Karen and I reported to the Bone Marrow Transplant Clinic on Monday morning. The doctors had reviewed the results of a CT scan of Karen's lungs that had been done the previous week. The scan showed something in her lung that had to be investigated before the transplant could be done.

 

The doctors decided that there would be a better chance of success if the stem cell harvest and transplant were done on the same day.

 

This was the second time the stem cell transplant had been cancelled. I was beginning to wonder if this transplant would ever happen. Karen posted the following message on Facebook:

 

News Flash! Yet another at least 2 week delay with the stem cell transplant. They found what appears to be a fungal infection in one of my lungs, so that must be addressed now before starting the transplant procedures. Pray fungal infection be completely gone in 2 weeks.

I stayed in Kansas City and accompanied Karen to her doctor's appointments this week.